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However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences?<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12911-021-01548-0","type":"journal-article","created":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T10:04:41Z","timestamp":1623146681000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Persisting workarounds in Electronic Health Record System use: types, risks and benefits"],"prefix":"10.1186","volume":"21","author":[{"given":"Albert","family":"Boonstra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tess L.","family":"Jonker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjolein A. 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Neither the relevant Dutch Act on medical research involving human subjects (WMO: Wet Medisch-Wetenschappelijk onderzoek met mensen) nor the University required ethical approval for the type of work conducted in this research. This study is based on interviews, observations, closed meetings of hospital working groups and documentary research. All the participants of the focal hospital signed an informed consent form and were informed of the dissemination of the results. They allowed us to use the data they provided, including the use of quotes, under conditions of confidentiality.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The management of the hospital granted access to research participants, meetings and documents, and further consented to publication under the condition of anonymity of the hospital, the department involved and the individual participants. All interviewees participated on a voluntary basis and were granted anonymity. We obtained permission from interviewees and from the organization\u2019s management to use the data, including quotations from the interviews, for scientific publication purposes.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"183"}}